The Most Common Causes of Infertility & How They’re Treated

You don't expect it. Maybe you've spent years trying not to get pregnant, assuming that when you were finally ready, it would just happen. But then months go by. The calendar fills with hope and disappointment. And the question settles in: what's going on?

Female Fertility Issues

When you're trying to conceive, your body is asked to do something incredibly complex: sync hormones, grow and release an egg, prepare a womb, open the gates, and give sperm a smooth ride to its destination. If any part of that process falters, the whole system can stall. Let’s unpack what might be happening on the female side.

PCOS and Infertility

Polycystic Ovary Syndrome (PCOS) is a bit of a hormonal troublemaker. It’s one of the most common reasons for infertility, and yet it shows up in a variety of ways. Some women barely notice symptoms, others are slammed with irregular periods, hair growth, acne, or weight gain.

Here’s how PCOS can mess with fertility:

• Irregular ovulation or no ovulation at all
• Elevated androgen levels, which throw hormones out of sync
• Cysts in the ovaries that interfere with normal egg development
• Insulin resistance, which exacerbates hormonal imbalance

Treatment isn’t one-size-fits-all. Some women find that modest weight loss (even just 5-10%) can kickstart ovulation. Others respond well to medications like Letrozole or Clomid. If insulin issues are involved, Metformin might help. In more stubborn cases, IVF often opens the door.

Endometriosis 

Endometriosis effects on fertility can be loud. When tissue that resembles the uterine lining grows in places it shouldn’t, like the ovaries or fallopian tubes, it can spark inflammation, scar tissue, and a lot of chaos.

Here’s what might go wrong:

• Fallopian tubes become blocked or twisted
• Eggs get damaged or trapped
• The uterine lining doesn’t allow embryos to implant properly

Even mild endometriosis can slow things down. Diagnosis often involves laparoscopy, and treatment might include removing the rogue tissue, using hormonal meds to suppress further growth, or moving straight to IVF if anatomy has taken a hit.

Low Ovarian Reserve

A woman’s egg supply starts to decline long before she sees her first gray hair. By age 35, fertility takes a noticeable dip. By 40, it becomes more challenging, though far from impossible.

Signs that your egg reserve may be running low:

• Shorter or irregular cycles
• Bloodwork showing low AMH or high FSH
• Trouble conceiving despite regular periods

IVF with aggressive stimulation can help retrieve multiple eggs in one cycle. Supplements like CoQ10 or DHEA might support egg quality (only under medical advice). Donor eggs, while a big decision, have excellent success rates.

Male Fertility Issues

Male factor infertility is involved in nearly half of all infertility cases. And yet, it often gets overlooked. Men make new sperm constantly, but that doesn’t mean the quality is always top-notch.

Low Sperm Count and Poor Motility

Sperm need to show up in healthy numbers, swim straight, and reach their target. If there aren’t enough of them or they can’t move well, fertilization becomes a long shot.

Possible reasons include:

• Hormonal imbalances like low testosterone
• Obesity, alcohol use, or smoking
• Certain medications or drugs
• Environmental heat (like tight underwear, saunas, or hot tubs)

Treatments vary depending on the root cause. Lifestyle upgrades are often the first step: better nutrition, exercise, quitting smoking, reducing alcohol, and avoiding toxins. Supplements like zinc and selenium may help, too. If natural methods don’t work, assisted techniques like IUI or IVF with ICSI can bridge the gap.

Varicocele and Its Impact on Sperm Health

A varicocele is a tangled vein in the scrotum that raises the local temperature. And guess what sperm hate? Heat. This condition is surprisingly common and usually fixable.

Signs might include:

• A dull ache in the testicles
• Noticeable swelling or lumpy veins
• Lower sperm quality in a semen analysis

Surgical repair often improves outcomes. If surgery isn’t successful, ICSI is a solid next step.

Unexplained Infertility: What It Means

You run all the tests, hormones look normal, tubes are clear, sperm check out. And still, no baby. That’s the black hole of unexplained infertility. About 10 to 20% of couples fall into this category.

Possible culprits include:

• Microscopic issues with egg or sperm quality
• Inflammation or immune dysfunction
• Implantation issues that don’t show up on imaging

Doctors might recommend a mix of:

• Lifestyle optimization
• Ovulation-stimulating meds
• IUI to increase chances during your fertile window
• IVF, sometimes with genetic testing to look deeper

It’s frustrating not to have a clear answer. But unexplained doesn’t mean untreatable.

Fertility Treatment Options for Every Condition

No two journeys are the same. Your fertility plan depends on your diagnosis, your goals, your budget, and your emotional bandwidth. Here are the most common options:

• Lifestyle changes: Sometimes the basics are overlooked. Sleep, stress, food, and exercise can shift your entire hormonal landscape.
• Medications: Clomid and Letrozole stimulate ovulation. Injectable gonadotropins are more aggressive.
• IUI: A simple in-office procedure where washed sperm is inserted directly into the uterus.
• IVF: The gold standard for many. Eggs and sperm meet in a lab, and the embryo is placed into the uterus.
• ICSI: When sperm issues exist, a single sperm is injected directly into an egg.
• Donor options: Eggs, sperm, or embryos from donors can drastically improve success rates.
• Surrogacy: Ideal for women who cannot carry a pregnancy.

Fertility medicine isn’t just about science. It’s also about timing, resilience, and trust in your care team.

Conclusion

Infertility isn’t some mysterious, distant medical anomaly. It's real, it's personal, and it's something millions of couples face. If you’re in that place, frustrated, curious, maybe a little scared, know this: you're far from alone. This isn’t about blame, it's about biology. And understanding the possible causes is a powerful first step toward getting the support and solutions you deserve.

FAQs

What are the top causes of female infertility?

The top causes of female infertility include PCOS, endometriosis, age-related decline or low ovarian reserve, blocked fallopian tubes, fibroids, uterine abnormalities, or hormonal imbalances.

What is unexplained infertility?

Unexplained fertility happens when everything appears normal, but conception doesn’t happen. There could be subtle issues not picked up by testing, like minor immune responses, undetected egg/sperm quality concerns, or implantation dysfunctions.

Can infertility be cured?

Not always, but most causes have a workaround. Hormonal imbalances and PCOS are often treatable. IVF can bypass blocked tubes. Donor gametes can overcome severe quality issues.

How do I know if I need IVF?

IVF may be recommended if:

• Your tubes are damaged
• You have severe male factor infertility
• Multiple IUIs have failed
• Age-related decline is a concern
• You want to test embryos before implantation

What are my options if I have low ovarian reserve?

If you have a low ovarian reserve, FCOC can recommend IVF with stronger stimulation, donor eggs, embryo or egg freezing, certain supplements (CoQ10, DHEA) under doctor supervision, or even IVF banking, where embryos are saved from multiple cycles.